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The Texas Division of Workers Compensation has adopted rules to implement legislation for processing bills related the medical treatment of injured workers at federal military treatment facilities, the agency announced Monday.
In June, Gov. Greg Abbott signed into law S.B. 935, which established requirements for processing medical bills related to services provided by injured workers and created a medical despite resolution process designed to address disputes over charges billed by federal military treatment facilities.
The rules clarify the bill processing requirements outlined in the legislation and also state that insurers may only deny a medical bill based on medical necessity, compensability, extent of injury or liability, and require insurers to report the first bill received from a military facility to the DWC.
The rules also outline dispute resolution requirements. Under the rules, medical necessity disputes regarding care provided by a federal military treatment facility will be adjudicated pursuant to Texas Administrative Code, but the rule also allows an injured employee to initiate a dispute or request reconsideration, and mandates that the insurer is responsible for all independent review organization fees. The rules also stipulate that all other disputes must be handled under the existing process for benefit review conferences, and that first responders may request expedited dispute resolution.
The DWC’s rules will apply to any health care provided at a federal military treatment facility on or after Jan. 1, 2020, regardless of the date of injury.
Medical networks in the Texas workers compensation system continue to have a positive effect on patient outcomes and costs, according to the Texas Division of Workers Compensation’s 2019 Network Report Card released Tuesday.